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The U.S. on Thursday dropped the most powerful conventional bomb in its arsenal on Nangarhar, Afghanistan.

The bomb, known in military ranks as “MOAB,” or the “mother of all bombs,” was used Thursday for the first time in combat, though it was developed in the early 2000s.

U.S. Army Gen. John Nicholson, commander of U.S. forces in Afghanistan, ordered the bomb dropped, according to reports. The target was believed to be ISIS tunnels and personnel in the Achin district of Nangarhar.

"This is the right munition to reduce these obstacles and maintain the momentum of our offensive against ISIS-K," he added, using the U.S. military's acronym for the IS affiliate.

The Air Force has revealed an image of the B-21, a highly secretive, next-generation stealth bomber designed to replace an aging fleet of older planes flying missions around the world.

Secretary of the Air Force Deborah Lee James unveiled the illustration Friday for the first time at an Air Force Association convention in Orlando, Florida.

“We have an image. We have a designation, but here’s what we don’t have,” she told the audience. “We don’t yet have a name.”

James called on airmen and others to suggest names for the stealthy aircraft under development it had previously been known simply as the Long Range Strike-Bomber, or LRS-B.

“The main reason for releasing this picture is to make the program real for legislators, who, up to now, have seen it as kind of an abstraction or concept rather than a concrete item,” said Loren B. Thompson, a senior defense analyst with the Virginia-based Lexington Institute and a defense industry consultant.

The Air Force could buy between 80 to 100 of the Northrop Grumman bombers, which resemble the bat-winged B-2 Spirit.

Costs are not finalized, but the program could reach up to $80 billion by one estimate when research and development and procurement are factored in.

Designated as the first “21st century bomber,” the B-21 eventually would replace the workhorse B-52 Stratofortress, first flown in the 1950s, and the swing-wing B-1 Lancer, launched in the 1980s. The new bomber jet would join the fleet in the mid-2020s.

Congressional legislators will scrutinize the secretive bomber, because the Air Force cannot afford all the new weapons programs targeted in future years, Thompson said.

“The Air Force is trying to bolster the case for its new bomber in a Washington political culture that is suspicious of anything secret,” he said. “Sen. John McCain’s statement this week that he would oppose open-ended funding of the bomber’s development underscores the political challenge the Air Force faces.”

McCain, R-Ariz., is chairman of the Senate Armed Services Committee.

The new design corrects issues with the B-2 that rendered it more detectable in some situations, Thompson added.

“The only thing an adversary can learn from looking at this picture (of the B-21) is that most of their existing radars are going to be useless in being able to detect it,” he said.

The B-21 design was chosen over a rival Boeing and Lockheed Martin team to build the next generation jet. Boeing filed a protest with the Government Accountability Office last year over losing the contract, but the GAO this month upheld the Air Force selection of Northrop Grumman.

The Air Force also bypassed the Fighters and Bombers Directorate, headquartered at Wright-Patterson, and gave oversight of the secretive plane’s research and development to the Rapid Capabilities Office in Washington, D.C.

The new stealth bomber would be built to fly from the continental United States and penetrate increasingly sophisticated air defenses of potential adversaries, Air Force officials have said.

“What you see in the artist’s rendering released by the Air Force is all the electronic items that will help make the plane lethal and survivable — items like an agile radar, passive sensors and a jamming system,” Thompson said.

Howard “Scrappy” Johnson knows how to take charge — and when to simply follow orders.

During a military career in which he was highly decorated, Johnson rose to the rank of colonel in the Air Force and flew scores of bombing runs during the Korean and Vietnam wars. Johnson also trained pilots in World War II and set a world altitude record in 1958 by soaring 91,249 feet in an F-104A Starfighter.

But when it comes to Joint Mission, a nonprofit organization that provides home furnishings for veterans and their families, it’s Johnson’s wife of 28 years, Elena, who is running the show.

“I’m just the secretary,” cracks the 95-year-old Johnson, who joined his wife for the kickoff of the organization Sunday during the annual Veterans Day Parade down Clematis Street in West Palm Beach. To promote the project, Elena and Scrappy rode on a 75-foot float flanked by veterans.

Scrappy may be the war veteran, but the vision for Joint Mission came from Elena, 85, a charming, energetic Italian-born mother of five who ran consignment shops in Royal Palm Beach and Palm Beach Gardens with her husband for decades before selling the businesses last year.

“My dream was to dedicate the rest of my life to veterans,” Elena Johnson said.

Johnson was looking for a philanthropic venture a few years ago when she and Scrappy gifted $1,700 to a local homeless veteran and his family, who were living under a bridge. The Johnsons’ generosity got the veteran and his family into a home and allowed them a new beginning. They’ve been thriving ever since, the Johnsons said.

“It made so much difference for that one family,” Elena Johnson said. “It was overwhelming. We had to get more involved.”

Enter Joint Mission.

Working with the local branch of the U.S. Department of Veterans Affairs, the organization is already making a difference. The group recently outfitted the homes of three veterans, including one belonging to Bruce Rynearson, of West Palm Beach.

After serving more than four years in the Air Force and seven years in the active reserves, Rynearson earned a degree in management informational systems and enjoyed a successful professional career until he “fell on some bad times.” Rynearson, 53, said his problems revolved around “personal stuff” but admits they led to him becoming homeless before he was able to “dig myself out of a hole.”

Rynearson’s plight was brought to the attention of the Johnsons, who provided his unfurnished home with bar stools, lamps, a couch, wicker chairs and other necessities.

“They’re amazing people,” Rynearson said. “To be that age and to be that sharp and strong mentally and to want to give back to veterans, it’s a very godly thing.”

Even though she was born in Italy, Elena Johnson has been connected to the U.S. military much of her life. Her first husband, Walter O’Brien, was an Army sargeant major who died at age 37 of lung cancer. Four of their five children served in the military.

Elena, an interior designer, and Scrappy, then a cattle rancher who was also widowed, met in Texas and married in 1990.

After running their consignment shops — True Treasures — for most of their married life, the Johnsons have taken up a new project to keep them busy.

“We want to dream big,” Elena Johnson said. “But because of our age, time is against us. We have to work right now. Fast.”

Since selling their businesses, the Johnsons have invested more than $60,000, time and effort into Joint Mission. Elena said they hope to open a warehouse to store donated furniture. For now, the Johnsons are using their Palm Beach Gardens home as a base of operations.

Rynearson said he’s grateful for the Johnsons and their help.

“It’s been a godsend,” Rynearson said. ” Now I can have my mother over. She’s 93 and now I have a nice place for her to sit.”

To bring you this story, reporters here and with Cox Media Group television stations and newspapers nationwide spent months reviewing court documents and sorting through a huge federal database to identify victims and the cost to taxpayers of medical malpractice payouts by the U.S. Department of Veterans Affairs.

The U.S. Department of Veterans Affairs paid out roughly $845 million in malpractice cases during the past 10 years — a period that has seen the agency face scrutiny for giving bonuses to medical professionals who provided or oversaw substandard care.

The payouts reached a high point in 2012, a Cox Media Group nationwide investigation found, leaving government watchdogs and members of Congress wondering if the VA is learning from its mistakes.

“The VA likes to say they’re accountable. I don’ t believe the word even exists in the VA dictionary,” said Rep. Jeff Miller, R-Florida, chairman of the House Committee on Veterans Affairs.

Cox reporters analyzed federal treasury data that found taxpayers spent more than $800 million paying 4,426 veterans and their family members who brought malpractice claims against the VA medical system since 2003. In 2012, a total of 454 financial settlements and awards added up to $98.3 million.

“This is something that has been going on for close to a decade and yet we haven’t seen major reform happen at the Department of Veterans Affairs,” said Daniel Epstein, executive director of the Washington-based group Cause of Action.

Reporters went behind the numbers to talk to families who said all that money was not worth what led to the payouts: a flag-draped casket or a brave man or woman left broken.

Their stories were wrenching: a 20-year Marine Corps veteran who went in for a tooth extraction and is now paralyzed and unable to talk; the Vietnam War veteran who died from cancer after doctors failed to note evidence in multiple X-rays over three years; the Korean War veteran who went in for a routine biopsy and bled to death without being checked on for hours.

VA officials point out that they manage one of the nation’s largest medical networks, and say the number of malpractice claims are relatively low. In 2012, the VA treated more than 6.3 million veterans and had only 1,544 claims filed.

Dr. Anupam Jena, an assistant professor at Harvard University, noted that the VA pays out on about 25 percent of claims. Meanwhile, private sector health systems pay out for about 20 percent, according to a study he participated in of 40,000 doctors published in The New England Journal of Medicine.

“Are VA doctors worse than other doctors?” he said. “No.”

But the 454 payments issued in 2012 are the second most in 10 years, eclipsed only by 462 payouts in 2008.

“It’s very apparent because of the spike in payouts that have been happening over a number of years that they’re woefully falling behind on a curve that they never should be behind in the first place,” Miller said.

‘Something should change’

The veterans’ stories often start the same.

“He trusted them all,” said Veronica Boritz. “Bill always felt that the Air Force had promised him care as he grew older, and that was where he should go, so he did.”

Bill was a retired Air Force captain who flew B-52s in Vietnam. He went to the VA medical center in nearby Atlanta with a heart arrhythmia, and underwent a laser surgery that accidently punctured his heart.

That was only the beginning. Bill was treated and released, but repeatedly went to the emergency room because of dizziness. He was placed on several medications. During his final ER visit it was discovered that his organs were failing and his heart was still bleeding. Doctors told Veronica they would do emergency surgery.

“Shortly after that I was out in the hallway and the alarms went off. And I kept telling myself it wasn’t Bill,” she said.

But it was.

“He wasn’t just somebody I knew who died. He was my whole life,” she said.

She asked for an autopsy and the hospital did an internal investigation that found he died from neglect, she said. After years of legal wrangling with the VA, she accepted a $300,000 settlment.

It doesn’t feel like justice, Boritz said. The doctor who she said made the fatal mistake was never held liable. Unlike in private practice, federal rules say she could only bring a malpractice suit against the VA, not the doctor.

“I think that seems an intrinsic right. The person who did the damage should suffer something,” she said. “Something should change. Someone should be held accountable.”

Poor performance rewarded

While being protected from malpractice lawsuits, VA doctors, nurses and administrators routinely receive pay raises and transfers the same year they are found to have provided substandard care.

A U.S. Government Accountability Office report in July found that in 2011 the VA gave performance bonuses and awards totaling $160 million to medical providers without adequately linking that extra pay to their performance.

The performance bonuses averaging $8,049 went to 18,500 medical providers – or about 80 percent of the total of eligible providers. Performance awards averaging $2,587 went to about 20 percent.

Federal auditors looked at records from VA centers in Georgia, Maine, Texas and Washington and found several examples of providers who made mistakes still getting bonuses. They included:

A radiologist who failed to read mammograms competently, but received a bonus of $8,216.

A surgeon who received $11,819 after he was suspended without pay for two weeks for leaving a surgery early.

A physician who refused to see emergency room patients in the order they were given to him, leaving some waiting more than 6 hours, but he got a $7,500 bonus.

A physician who practiced with an expired license for three months but received a $7,663 bonus.

Bonuses also went to VA hospital administrators who oversaw massive failures at their medical centers. They included:

The man who oversaw the Pittsburgh VA during a legionnaires outbreak that led to five veterans dying and 21 becoming ill, received a $62,895 service award shortly after the outbreak was revealed.

An Atlanta VA Medical Center director pocketed a $13,000 bonus in 2011 and another $17,000 worth of salary bonuses in 2010 while an audit found management problems contributed to two veterans committing suicide.

The director of the Dayton VA Medical Center received an $11,874 bonus in 2010 and was transferred to a headquarters job in 2011 following revelations that a dentist there failed to change gloves and sterilize equipment between procedures for more than a decade, putting possibly thousands of veterans at risk.

Not only are these doctors and administrators not named in malpractice suits, but the money to pay malpractice claims doesn’t even come out of the VA budget. It comes out of a federal treasury fund set aside to pay legal settlements against the government.

“They use bonuses like handing out candy at the VA,” said Rep. Miller. “You usually discipline somebody by removing them from the position that they’re in, and that’s not the VA’s modus operandi. They move them to another hospital somewhere.

“I don’t know if removing the immunity is the way to go, but certainly having them feel the pain of these settlements or these awards being given out, I think is probably the only step that’s going to make a difference.”

Tooth extraction leaves veteran paralyzed

The largest malpractice payout in 10 years was for $17.5 million. It was awarded in 2012 to a Philadelphia Marine Corps veteran left permanently paralyzed by a routine tooth extraction.

Christopher Ellison, who had served in the military for 20 years, went to the Philadelphia VA in 2007 to have several teeth removed. His blood pressure was dangerously low, but physicians went ahead with the procedure. He had a catastrophic stroke on his drive home and crashed his car two-tenths of a mile from the VA.

Home video supplied by Ellison’s family shows the extent of his brain damage. He struggles to walk, communicate, or even peel a banana on his own. He requires around-the-clock care.

“I’ve never had a client where he wouldn’t have traded the money he received to for the injury,” said Ellison’s attorney, Shanin Specter. “The injury is always worse than the benefit of the financial compensation.”

Another large payout went to J.R. Howell, who was rushed to the Memphis VA emergency room in 2006 with abdominal pain, then sent home without a proper diagnosis. A neighbor stopped by to check on him at home and found him unresponsive.

“She said, ‘Honestly I thought you were dead,’ ” he said.

He was rushed to the hospital again and ended up in a coma. When he awoke he was partially paralyzed. He was awarded $5.7 million last year.

Howell was drafted during the Vietnam War.

“We’ve seen battle. We’ve seen combat. And why do we have to come back home and fight when we come back home just to get proper medical care?” he said.

When Army veteran Thaddeus Raysor had an X-ray done at the North Florida/South Georgia Veterans Health System in August 2006, his widow said the staff failed to diagnose a 1-centimeter lesion on his left lung. They missed it again in 2007. By November 2008, it had grown to 8 centimeters, and the radiologist referred it for further evaluation.

But the studies weren’t ordered, and Raysor wasn’t told, according to his family.

By August 2009, a final X-ray showed the mass had grown to 9.5 centimeters and spread through both lungs. Raysor died Nov. 14, 2009, more than three years after his initial X-ray.

His family was awarded $875,000 last year.

VA responds

Department of Veterans Affairs officials declined to be interviewed for this story. Instead the agency issued a statement that read in part:

“VA takes this issue very seriously and Veterans Health Administration (VHA) personnel remain committed to maintaining a high level of quality care, transparency and accountability.”

Agency analyses of patient mortality and safety have found that VA medical centers outperform top health systems across the country, according to agency officials.

Unlike private sector hospitals, the VA system has a built-in process for making malpractice claims. It starts with an administrative claim that must be filed within two years of when the mistake took place. The VA has six months to offer a settlement before the claimant can take the issue to court.

U.S. Rep. Phil Gingrey, a licensed OB-GYN, expressed concern that VA doctors are largely held unaccountable because incidents are not even reported to state medical boards.

“They’re not worried about losing their medical license, or worried about their hospital privileges being suspended, or their contract to work in that facility not being renewed, which is all applicable in the private sector,” said the Georgia Republican.

The VA embraces a disclosure policy that informs patients when the hospital becomes aware of an accident, negligence or even a near miss.

Attorneys interviewed for this story said the VA’s disclosure policy likely cuts down on claims, as does the law limiting attorney fees to 20 percent of settlements or 25 percent of awards — which keeps some attorneys from taking cases. This is in addition to limits in some states on malpractice awards.

“(This) ends up hurting patients who are badly injured as a result of real malpractice,” said Niley Dorit, who represents malpractice claims in California, which also limits total malpractice awards at $250,000.

Dorit represented John Lee Mackey, an Army veteran who died in 2009 after he went into the hospital with dehydration and doctors accidentally ran a catheter into his heart.

Bleeding to death

Veterans’ family members interviewed for this story said they had to be their own advocate in asking for medical records and investigations.

“I found out by reading the reports, which were thick as a book, on the things that they didn’t do,” said Virginia Pennington, who said the Dayton VA, where her husband Charles died, did not fess up.

Charles went into the hospital because he wasn’t feeling well, and a blood test led to a liver biopsy. It seemed a routine procedure, so Virginia went home. When her phone rang the next morning, she assumed it was her husband letting her know how it went. Instead it was the hospital informing her he was dead.

“And so I didn’t get to talk to him,” she said. “Maybe if I would have been there I would have known they weren’t taking care of him, and it could be corrected at that time.”

The blood thinner the Air Force veteran was on led him to bleed to death in a hospital room where he wasn’t checked on for hours after his surgery, she said.

“The records said he was supposed to be checked every half hour,” she said, “and the records said, when we received them, that they hadn’t checked on him at all.”

Pennington settled for a $150,000 payout.

Ohio attorney Stephen O’Keefe, who specializes in VA malpractice claims, said he expects the dollar amount to rise as the VA handles a younger population returning from Afghanistan and Iraq. More money is awarded if the affected veteran is younger.

“I think you will continue to see an uptick in payouts,” O’Keefe said. “In an ideal world, I would like to see my job go away, where people don’t need an attorney to assist them when they have been injured by a physician or a nurse. But the reality is that’s never going to happen.

“When there are humans in the system there are going to be errors.”

The questions become, according to Cause of Action’s Epstein: Why are the payouts increasing, and what is the VA doing to solve the problem?

“If it’s the case that it isn’t waste, fraud and abuse of our federal dollars, it’s the (VA’s) responsibly to disclose that, and explain why.”